Healthcare Provider Details

I. General information

NPI: 1659600971
Provider Name (Legal Business Name): MARTHA MARIE KAITON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 UNION AVE SE
GRAND RAPIDS MI
49503-4721
US

IV. Provider business mailing address

340 UNION AVE SE
GRAND RAPIDS MI
49503-4721
US

V. Phone/Fax

Practice location:
  • Phone: 818-448-3523
  • Fax:
Mailing address:
  • Phone: 818-448-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28676
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501020010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: